IStock Photo 7847118 © Sean O'Riordan

By the time we reach adulthood, our lives have been full of tests. We’ve been graded on our performance in everything from spelling to calculus. In fact, most people receive their first test as soon as they are born. Within a few minutes of birth, babies born at just about any modern medical facility are given an Apgar score that rates their overall health.

The Apgar score became widely used in the 1950s; before it, there was no way of evaluating in a systematic way the health of newborns and the success of deliveries. It was developed by Dr. Virginia Apgar, who was working as an anesthesiologist at Columbia University College of Physicians and Surgeons, where she was the first woman to become full professor.

Apgar was studying anesthesia of women during childbirth when she thought up a fast and simple way of scoring the health of newborns. Babies are evaluated by five different criteria: heart rate, respiratory effort, muscle tone, reflex response, and color. For each of these, the baby is given a 0, 1, or 2, with 2 representing a normal, healthy status.

Apgar presented her score at a medical meeting in 1952. Though it encountered some skepticism at first, as the test was gradually adopted in medical facilities around the world it revolutionized the treatment of newborn babies. For the first time they were regarded as patients in their own right, and there was a new imperative for obstetricians to take immediate action to save newborns in distress.

Although seemingly simple, the ability to put a number on a baby’s health spurred many medical advancements, including the development of neonatology units dedicated to saving the lives of babies once thought too small or ill to survive. The Apgar score also gave Virginia Apgar and other researchers a way of seeing how different interventions on the mother such as anesthesia affected the success of her delivery.

Fortunately, the first test of our lives is one we have a very good chance of passing. In the US, the odds a baby will have an excellent 5-minute Apgar score (9 or 10) are 1 in 1.13 (88%), while the odds that a baby will receive a poor 5-minute Apgar score (below 7) are 1 in 62.5 (1.6%).

The Apgar score does have limitations and doesn’t necessarily predict the future health of a baby. But more than 50 years after its invention, the Apgar score remains a useful way of assessing how well a newborn has made the transition outside the womb.